A nurse on the postpartum unit is caring for four clients. For which of the following clients should the nurse notify the provider?

A client who reports luchia rubra requiring changing perineal pads every 3 hr

A client who has a urinary output of 300 mL in 8 hr

A client who is receiving magnesium sulphate and has absent deep tendon reflexes

A client who reports abdominal cramping during breastfeeding

Answer and Explanation

The Correct Answer is C

A. A client who reports lochia rubra requiring changing perineal pads every 3 hr: Lochia rubra is the normal discharge during the early postpartum period. Changing perineal pads every 3 hours is within the expected range and does not warrant immediate notification of the provider.

B. A client who has a urinary output of 300 mL in 8 hr: Although the urinary output is relatively low, the information provided is not sufficient to conclude that this is abnormal. Further assessment is needed, and this finding alone may not be an emergency. However, it should be monitored.

C. A client who is receiving magnesium sulfate and has absent deep tendon reflexes: Absent deep tendon reflexes can be a sign of magnesium toxicity. Magnesium sulfate is used for various indications, such as preeclampsia or eclampsia, but it has a narrow therapeutic range. Absent deep tendon reflexes suggest the need for immediate attention and notification of the provider.

D. A client who reports abdominal cramping during breastfeeding: Abdominal cramping during breastfeeding is a common postpartum symptom associated with uterine contractions. It is a normal physiological response and does not require immediate notification of the provider.

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Correct Answer is B

Explanation

A. Firm rigid abdomen: A firm and rigid abdomen is more indicative of uterine hypertonicity or uterine hyperstimulation, which is not typically associated with placenta previa. It may be seen in conditions such as uterine rupture.

B. Painless vaginal bleeding: Placenta previa is a condition where the placenta partially or completely covers the cervix, leading to painless vaginal bleeding. This bleeding occurs because as the cervix begins to dilate and efface in preparation for labor, blood vessels in the placenta may rupture, causing bleeding. Importantly, this bleeding is typically painless and can be sudden and profuse.

C. Uterine hypertonicity: Uterine hypertonicity refers to excessive, uncoordinated uterine contractions. Placenta previa is not generally associated with uterine hypertonicity; instead, it is more commonly linked with uterine relaxation and potential bleeding during contractions.

D. Persistent headache: A persistent headache is not a typical finding in placenta previa. However, it could be associated with conditions like preeclampsia, which might coexist with placenta previa but is a separate concern.

A. Weak cry B. Poor feeding C. Respiratory rate of 30/min D. Absent moro reflex

Correct Answer is B

Explanation

A. Weak cry: A weak cry is not a specific manifestation associated with newborns exposed to methadone. Methadone-exposed newborns may show signs of neonatal abstinence syndrome (NAS), but a weak cry is not a primary characteristic.

B. Poor feeding: This is the correct answer. Poor feeding is a common manifestation of neonatal abstinence syndrome (NAS) in newborns exposed to opioids, including methadone. NAS can cause gastrointestinal symptoms, including feeding difficulties.

C. Respiratory rate of 30/min: While respiratory issues can be part of the neonatal abstinence syndrome, a specific respiratory rate of 30/min is not universally characteristic. NAS symptoms can vary among infants.

D. Absent Moro reflex: The Moro reflex is not typically affected in infants exposed to methadone. NAS symptoms often involve central nervous system irritability, but the Moro reflex is a complex primitive reflex that may remain intact.

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A nurse on the postpartum unit is caring for four clients. For which of the following clients should the nurse notify the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has a placenta previa. Which of the following findings should the nurse expect?

Correct Answer is B

Explanation

A nurse is assessing the newborn of a client who reports methadone use during pregnancy. The nurse should expect the newborn to exhibit which of the following manifestations?

Correct Answer is B

Explanation

A nurse is caring for a newborn who was born at 39 weeks of gestation and is 36hr old. Exhibits Which of the following findings should the nurse report to the provider? Select all that apply

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